Ultra-processed foods consumption as a promoting factor of greenhouse gas emissions, water, energy, and land use: A longitudinal assessment.

BACKGROUND: Dietary patterns can produce an environmental impact. Changes in people's diet, such as the increased consumption of ultra-processed food (UPF) can not only influence human health but also environment sustainability. OBJECTIVES: Assessment of the impact of 2-year changes in UPF consumption on greenhouse gas emissions and water, energy and land use. DESIGN: A 2-year longitudinal study after a dietary intervention including 5879 participants from a Southern European population between the ages of 55-75 years with metabolic syndrome. METHODS: Food intake was assessed using a validated 143-item food frequency questionnaire, which allowed classifying foods according to the NOVA system. In addition, sociodemographic data, Mediterranean diet adherence, and physical activity were obtained from validated questionnaires. Greenhouse gas emissions, water, energy and land use were calculated by means of the Agribalyse® 3.0.1 database of environmental impact indicators for food items. Changes in UPF consumption during a 2-year period were analyzed. Statistical analyses were conducted using computed General Linear Models. RESULTS: Participants with major reductions in their UPF consumption reduced their impact by -0.6 kg of CO2eq and -5.3 MJ of energy. Water use was the only factor that increased as the percentage of UPF was reduced. CONCLUSIONS: Low consumption of ultra-processed foods may contribute to environmental sustainability. The processing level of the consumed food should be considered not only for nutritional advice on health but also for environmental protection. TRIAL REGISTRATION: ISRCTN, ISRCTN89898870. Registered 05 September 2013, http://www.isrctn.com/ISRCTN89898870.

A phase 3, randomised, double-blind, placebo-controlled clinical trial evaluation of the efficacy and safety of a SARS-CoV-2 recombinant spike RBD protein vaccine in adults (ABDALA-3 study).

Background: The pandemic of COVID-19 raised the urgent need for safe and efficacious vaccines against SARS-CoV-2. We evaluated the efficacy and safety of a new SARS-CoV-2 virus receptor-binding domain (RBD) vaccine. Methods: A phase 3, multicentre, randomised, double-blind, placebo-controlled trial was carried out at 18 clinical sites in three provinces of the south-eastern region of Cuba. Subjects (healthy or those with controlled chronic diseases) aged between 19 and 80 years, who gave written informed consent were eligible. Subjects were randomly assigned (1:1, in blocks) to two groups: placebo, and 50 µg RBD vaccine (Abdala). The product was administered intramuscularly, 0.5 mL in the deltoid region, in a three-dose immunization schedule at 0-14-28 days. The organoleptic characteristics and presentations of the vaccine and placebo were identical. All participants (subjects, clinical researchers, statisticians, laboratory technicians, and monitors) remained blinded during the study period. The main endpoint was to evaluate the efficacy of the Abdala vaccine in the prevention of symptomatic COVID-19. The trial is registered with the Cuban Public Registry of Clinical Trials, RPCEC00000359. Findings: Between March 22 to April 03, 2021, 48,290 subjects were included (24,144 and 24,146 in the placebo and Abdala groups, respectively) in the context of predominant D614G variant circulation. The evaluation of the main efficacy outcomes occurred during May-June 2021, starting at May 3rd, in the context of high circulation of mutant viruses, predominantly VOC Beta. The incidence of adverse reactions for individuals in the placebo and Abdala vaccine groups were 1227/24,144 (5.1%) and 1621/24,146 (6.7%), respectively. Adverse reactions were mostly mild, and from the injection site, which resolved in the first 24-48 h. No severe adverse events with demonstrated cause-effect relationship attributable to the vaccine were reported. Symptomatic COVID-19 disease was confirmed in 142 participants in the placebo group (78.44 incidence per 1000 person-years, 95% confidence interval [CI], 66.07-92.46) and in 11 participants in Abdala vaccine group (6.05 incidence per 1000 person years; 95% CI 3.02-10.82). The Abdala vaccine efficacy against symptomatic COVID-19 was 92.28% (95% CI 85.74-95.82). Moderate/serious forms of COVID-19 occurred in 30 participants (28 in the placebo group and only 2 in the Abdala vaccine group) for a vaccine efficacy of 92.88% (95% CI 70.12-98.31). There were five critical patients (of which four died), all in the placebo group. Interpretation: The Abdala vaccine was safe, well tolerated, and highly effective, fulfilling the WHO target product profile for COVID-19 vaccines. Those results, along with its immunization schedule and the advantage of easy storage and handling conditions at 2-8 °C, make this vaccine an option for the use in immunization strategies as a key tool for the control of the pandemic. Funding: Centre for Genetic Engineering and Biotechnology (CIGB), Havana, Cuba.

In vitro and In vivo Synergistic Interactions of the Flavonoid Rutin with Paracetamol and with Non-Steroidal Anti-Inflammatory Drugs.

AIM/BACKGROUND: The combination of drugs with different mechanisms of action could be more effective due to an enhanced synergistic activity. The pharmacological interactions between rutin and paracetamol, and rutin and non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen, ketorolac, and diclofenac were investigated using in vitro and in vivo assays. METHODS: Individual and drug combination response curves of rutin-NSAIDs, and rutin-paracetamol (each at 0.001-0.1 mmol for in vitro studies and ranging from 1.25-100 mg/kg p.o. for in vivo studies) were evaluated in RAW 264.7 macrophages [inhibition of nitric oxide (NO) using the Griess reagent] and Balb/c mice (acetic acid-induced writhing test). An isobolographic analysis was used to assess the type of interaction between rutin and NSAIDs and rutin-paracetamol in a proportion of 1:1. RESULTS: Rutin alone and in combination with paracetamol and NSAIDs decreased NO production and the number of writhings in a concentration/dose-dependent manner. The isobolograms showed that all in vitro combinations of rutin-NSAIDs and rutin-paracetamol exerted synergistic effects. The combination rutin-diclofenac showed an interaction index of 0.17. In the in vivo assay, the combinations of rutin-diclofenac (interaction index = 0.195) and rutin-ketorolac (interaction index = 0.408) displayed synergistic effects, and the combination rutin-paracetamol exhibited additive effects. CONCLUSION: Rutin produces synergistic effects with paracetamol and NSAIDs in in vitro and in vivo assays.

A New Food Composition Database of Lactose-Free Products Commercialized in Spain: Differences in Nutritional Composition as Compared to Traditional Products.

We developed a new database to evaluate the nutritional composition of lactose-free products from Spain. The database includes dairy products and other products, all of which show the "lactose-free" declaration on their label, accounting for 327 products in total. Of these, 123 are dairy products, 16 are non-dairy products which include a dairy ingredient (5%) and 188 items (57% of the sample) are non-dairy products that do not contain any dairy ingredient. The main subgroups are yogurt (25%), milk (24%), and cheese (17%). Nineteen percent of the compiled products included nutritional claims on their labels. Most lactose-free products did not contain either added sugars or low- or no-calorie sweeteners (58%), while 34% included added sugars and only 6%, sweeteners or a combination of both (2%). We found that 19.5%, mainly within the milk subgroup, were fortified with vitamins A, D, E, K, B9, and B12, P, and Ca. There were no significant differences in the nutritional composition between lactose-free products and traditional products. According to the NOVA classification, 55% of compiled lactose-free products were ultra-processed, and 20% processed. The array of lactose-free products marketed in Spain proves that there are enough, both in quantity and quality, to satisfy the dairy needs of lactose intolerants.

Proceso enseñanza aprendizaje del pregrado en Atención Primaria de Salud durante el primer enfrentamiento a la COVID-19 / Teaching learning process in first health care attention during the first attempt to face covid-19

RESUMEN Introducción: Las universidades médicas cubanas enfrentan el desafío, en medio de la pandemia de COVID-19, de mantener la formación de recursos humanos y apoyar directamente las acciones para evitar el contagio de la población. Objetivo: describir el desarrollo del proceso enseñanza aprendizaje durante la integración de estudiantes de las carreras de la Salud a la Atención Primaria en la lucha contra la COVID-19 Método: Se desarrolló un estudio descriptivo transversal de marzo a julio del 2020 en el municipio Santo Domingo, provincia Villa Clara. Además se recopiló información de archivos del Departamento Docente y de Higiene Municipal. Fueron insertados 305 estudiantes y 15 profesores en 44 consultorios, previo análisis contextual se implementó modificaciones en las estrategias didácticas para la educación a distancia a través de uso de datos en telefonía móvil empleando aplicación whatsapp. Resultados: Con predominio de métodos asincrónicos, se logró mantener un flujo informativo y actualizado de las estadísticas necesarias para los partes diarios, la información sobre diferentes asignaturas, estado de salud de los alumnos y profesores, se fortaleció el trabajo político ideológico al contrarrestar la infodemia y otras campañas de desinformación al establecer vínculos con otros grupos administrados por la FEU y el grupo de comunicadores de la Universidad. Conclusiones: La respuesta dinámica del claustro con inserción de las Tecnologías de la Información y las Comunicaciones durante la labor de pesquisa permitió dar continuidad al proceso enseñanza aprendizaje y la obtención de resultados exitosos en el primer enfrentamiento a la pandemia en el municipio.

ABSTRACT Introduction: In Cuban Medical Universities, 2019-2020 course faces the challenge that, through the COVID-19 pandemic, the formation of human resources had to be maintained as well as to support directly actions to avoid the population contagious. Objective: To describe the teaching learning process development during the integration of health careers students to the primary health care attention in the battle against COVID-19. Method: In Santo Domingo, from March to July 2020it was developed a transversal descriptive study, information was collected from archives of the teaching and the municipal hygiene departments. In 44medical offices were inserted 305 students and 15 professors, previous contextual analysis it were implemented modifications on the didactics strategies for distance learning education by means of data on mobile phones using in this case the whatsapp application. Results: With the predominance of asynchrony methods, it was maintain the information process and the updating of the necessary statistics for the daily reports, different subjects orientations, students and professors health status, was strengthen the ideological and political work facing Infodemia and other fake information campaigns, helped by other groups too administered by FEU and the group of communicators from the university. Conclusions: The dynamic answer from the group of teachers with the insertion of communication and information technologies during the searching procedure made possible to continue the teaching learning process getting sucessful results during the first attempt to face COVID-19 in Santo Domingo municipality.

Sistema de actividades para desarrollar habilidades comunicativas en idioma Inglés en los residentes de Estomatología / System of activities for developing communication skills in the English language in dental residents

RESUMEN Fundamento: la preparación idiomática, según lo establecido por el Marco Común Europeo de Referencia (MCER), constituye una necesidad de primer orden en el proceso de formación y superación de los futuros profesionales de las ciencias médicas. Objetivo: diseñar un sistema de actividades para desarrollar habilidades comunicativas en idioma Inglés en los residentes de Estomatología. Métodos: se realizó un estudio descriptivo de corte transversal en la Facultad de Estomatología entre enero 2018-diciembre 2019. Se emplearon métodos teóricos: histórico-lógico, analítico-sintético, inductivo-deductivo y sistémico-estructural; empíricos: análisis documental, encuesta en forma de cuestionario a estudiantes y entrevista a informantes clave. Resultados: el diagnóstico realizado demostró la necesidad de diseñar un sistema de actividades que incluye tres folletos: el primero, con actividades para la impartición de clases dirigido a profesores y estudiantes; el segundo, con respuestas a interrogantes y orientaciones metodológicas generales y un set de audiciones auténticas con sus transcripciones; y el tercero, ofrece ayuda a los estudiantes en su estudio individual. Conclusiones: el sistema de actividades diseñado se caracteriza por su flexibilidad y enfoque interdisciplinar, tiene en cuenta el desarrollo de las cuatro habilidades del idioma, las subhabilidades y sus funciones. Fue valorado de forma satisfactoria por los especialistas quienes reconocieron sus adecuadas pertinencia social y pedagógica, estructura lógica, factibilidad, originalidad y valor científico-pedagógico.

ABSTRACT Background: language preparation, as established by the Common European Framework of Reference (CEFR), constitutes a first order need in the process of training and updating future professionals in the medical sciences. Objective: to design a system of activities to develop communication skills in the English language in Dentistry residents. Methods: a descriptive cross-sectional study was carried out at the Dentistry Faculty from January 2018 to December 2019. Theoretical methods were used: historical-logical, analytical-synthetic, inductive-deductive and systemic-structural; empirical ones: documentary analysis, survey in the form of a questionnaire to students and interview with key informants. Results: the diagnosis showed the need to design a system of activities that includes three booklets: the first, with activities for teaching classes aimed at teachers and students; the second, with answers to questions and general methodological guidelines and a set of authentic auditions with their transcripts; and the third, offers help to students in their individual study. Conclusions: the designed activity system is characterized by its flexibility and interdisciplinary approach; it takes into account the development of the four language skills, sub skills and their functions. It was satisfactorily evaluated by specialists who recognized its adequate social and pedagogical relevance, logical structure, feasibility, originality and pedagogical-scientific value.

Antimicrobial activity and inhibition of biofilm formation in vitro and on human dentine by silver nanoparticles/carboxymethyl-cellulose composites.

OBJECTIVE: To evaluate the antimicrobial activity of a silver nanoparticles/carboxymethyl-cellulose (AgNPs/CMC) composite on in vitro and dentine disc heterogeneous biofilms. DESIGN: AgNPs/CMC composite effect on normal human gingival fibroblast cells (HGF) viability was determined by the MTT reduction assay. In addition, we evaluated the antimicrobial effect of AgNPs/CMC composite on Candida albicans, Enterococcus faecalis, and Fusobacterium nucleatum growth in vitro and heterogeneous biofilms, as well as dentine disc biofilms. RESULTS: Quasi-spherical AgNPs/CMC composites, with a mean 22.3 nm particle-size were synthesized. They were not toxic to HGF cells at concentrations tested that were antimicrobial, however they caused significant cytotoxicity (89 %, p <  0.05) at concentrations > 15 µg/mL. In vitro, they inhibited up to 67 %, 66 %, and 96 % C. albicans, E. faecalis, and F. nucleatum growth at concentrations ranging from 1.2 µg/mL to 9.6 µg/mL, as compared with untreated control. We also demonstrated significant (p <  0.05) 58 % biofilm reduction by 4.8 µg/mL AgNPs/CMC composite on human dentine discs. CONCLUSION: AgNPs/CMC composite showed anti biofilm activity on monocultures, heterogenous cultures, and dentine discs, resulting a potentially effective alternative to prevent and eliminate infections after endodontic treatment.

A decrease in hepatitis C virus RNA to undetectable levels in chronic hepatitis C patients after PegIFNα + RVB or sofosbuvir + NS5A inhibitor treatment is associated with decreased insulin resistance and persistent oxidative stress.

Oxidative stress (OS) and insulin resistance (IR) induced by hepatitis C virus (HCV) infection, are involved in the development of chronic hepatitis C (CHC) complications and progression to hepatocellular carcinoma. The aim of this study was to investigate the effect of pegylated interferon alpha (IFNα) + ribavirin (PegIFNα+RVB) or sofosbuvir + NS5A inhibitor (SOF+InNS5A) on IR and the components of OS. HCV was genotyped in 20 CHC patients grouped by treatment with either PegIFNα+RVB (n = 10) or SOF+InNS5A (n = 10). The treatment's effect on OS-induced damage to lipids (HNE-HDL), proteins (advanced glycation end products [AGEs]), and DNA (8-OHdG) as well as the concentrations of proinflammatory cytokines (IL-2, TNFα, IFNγ), ALT, AST, GSH and platelets was determined. Superoxide dismutase (SOD) and catalase activity as well as IR, determined by the HOMA1-IR index, was evaluated. The HCV genotypes (GT) found were GT1b (45%), GT1a (30%), GT2b (20%), and GT2a (5%). Viral RNA became undetectable by week 12 with SOF+InNS5A in 100% of the cases and with PegIFNα+RVB in 70% of the cases. After viral RNA became undetectable, regardless of treatment and GT, a significant increase in the platelet concentration and SOD activity was observed, whereas ALT, insulin, and IR decreased (p < 0.05). However, only for the SOF+InNS5A treated group was there an increase in oxidative damage to lipids (p < 0.017) and proteins (p < 0.05). None of the other parameters demonstrated any differences. These data confirm that OS persisted after treatment with either SOF+InNS5A or PegIFNα+RVB. IR could be considered a response biomarker to treatment with direct-acting antivirals.

Impacto de la universalización en la formación y desempeño de profesionales de la salud / Impact of universalization on the training and performance of health professionals

RESUMEN Fundamento: el proceso de universalización de la enseñanza en la formación de profesionales de la salud posibilitó la educación médica en escenarios diversos donde antes solo se realizaba la atención primaria. Objetivo: valorar el impacto de la universalización en la formación y desempeño de los profesionales de la salud en la sede universitaria del municipio de Santo Domingo en Villa Clara. Métodos: se realizó un estudio de intervención en el proceso de universalización del período 2009-2017, las unidades de observación fueron el total de profesores activos categorizados para impartir la docencia y los estudiantes de la carrera de Medicina matriculados en los dos primeros cursos. Se utilizaron métodos teóricos: análisis-síntesis, inducción-deducción e histórico-lógico; y empíricos: el análisis documental de informes que ofrecieron los datos de comparación. Resultados: las cifras encontradas posibilitaron apreciar avances en los educadores en cuanto al tránsito de categorías docentes inferiores hasta profesores auxiliares, aumento de grados académicos y científicos concretados en mayor número de másteres, especialistas de segundo grado e investigadores agregados, y se incrementaron las publicaciones y la participación en eventos científicos nacionales e internacionales. La mayoría de los estudiantes se graduaron, y se mantienen en el sistema de salud aportando buenos resultados en la atención a la población, incluso algunos han cumplido misiones internacionalistas. Conclusiones: el proceso de universalización se valoró de forma positiva porque elevó de forma considerable las competencias en los profesionales del territorio y el desempeño de los graduados formados en esa modalidad de estudios universitarios.

ABSTRACT Background: the process of universalization of education in the training of health professionals enabled medical education in diverse settings where primary care was only performed before. Objective: to assess the impact of universalization in the training and performance of health professionals in Santo Domingo Municipality University branch in Villa Clara. Methods: an intervention study was carried out in the universalization process from 2009 to 2017, the observation units were the total number of active ranked teaching professors and the students of the medical degree enrolled in the first two courses. Theoretical methods were used: analysis-synthesis, induction-deduction and historical-logical; and empirical ones: the documentary analysis of reports that offered the comparison data. Results: the figures found made it possible to appreciate advances in educators in terms of the transition from lower teaching ranks to associate professors, increase in academic and scientific degrees specified in a greater number of masters, second degree specialists and assistant researchers, and publications and Participation in national and international scientific events. Most of the students graduated, they remain in the health system providing good results in the care of the population, and even some of them have completed internationalist missions. Conclusions: the universalization process was valued in a positive way because it significantly increased the competencies in the professionals of the territory and the performance of graduates trained in this modality of university studies.

Sistemas personalizados de dosificación en atención primaria: un estudio multidisciplinar / Dose dispensing service in a prymary health care area: A multidisciplinary study

Introducción: los sistemas personalizados de dosificación (SPD) preparados en farmacias son una opción para mejorar la adherencia terapéutica. Objetivo: describir las características y grado de implantación de los SPD bajo la perspectiva de profesionales sanitarios de un centro de salud, farmacéuticos comunitarios y pacientes adscritos a ese centro. Método: estudio descriptivo transversal en la zona de influencia del centro de salud Daroca (Madrid). Participaron 64 profesionales del centro de salud, 37 farmacéuticos comunitarios y 29 usuarios de SPD. Se utilizaron cuestionarios para cada una de las categorías con preguntas sobre conocimientos y opiniones de los SPD, gestión, preparación y satisfacción con el servicio. Resultado: conocen los SPD el 61,4 % de los profesionales del centro de salud y el 94 % creen que son útiles. Trece farmacias ofrecen los SPD: el 55,6 % considera que hay que contactar con el médico, el 41,7 % pone precio al servicio y el 92,3 % lo hace manualmente. Cinco farmacias preparan SPD a 18 pacientes de la zona. Criterios de inclusión más utilizados: edad, polimedicación y sospecha de mal cumplimiento. Perfil de paciente usuario de SPD: mujer octogenaria con estudios primarios polimedicada que vive sola. El 66,7 % de los pacientes encuestados tomaba los medicamentos directamente de la caja y al 88,9 % de ellos les recomendó el SPD el farmacéutico. El cien por cien de los usuarios de SPD está muy satisfecho con el servicio. Conclusión: aunque todos los colectivos estudiados creen que los SPD son útiles para mejorar la adherencia, existe una baja implantación de los SPD en nuestra zona

Introduction: Dose Dispensing Service (SPD) prepared in pharmacies are an option to improve therapeutic adherence. Objective: to describe the characteristics and implantation of SPD from the perspective of professionals of a health center, community pharmacists and patients attached to that center. Methods: Descriptive cross-sectional study in the area of influence of Daroca health center (Madrid). 64 health center professionals, 37 community pharmacists and 29 SPD users participated. Questionnaires were used for each of the categories with questions about knowledge and opinions of SPDs, management, preparation and satisfaction with the service. Results: 61.4% of health center professionals know SPD and 94% believe they are useful. 13 pharmacies offer SPD: 55.6% consider that they should contact the doctor, 41.7% charge for the service and 92.3% do so manually. 5 pharmacies prepare SPD for 18 patients in our local zone. Most used inclusion criteria: age, polymedication and suspicion of poor compliance. Patient profile using SPD: octogenarian woman polymedicated with primary studies living alone. 66.7% of the patients took the medications directly from the box. Pharmacists recommended SPD to 88.9% of patients. 100% of SPD users are very satisfied with the service. Conclusion: Although all the groups studied believe that SPDs are useful for improving adherence, SPDs have a low implementation in our area

Satisfacción de estudiantes y docentes con la educación en el trabajo desde la Atención Primaria / Student and teacher satisfaction with on-the-job training in primary health care

Introducción: La formación del estudiante de Medicina se basa en los principios de la vinculación del estudio con el trabajo. La educación en el trabajo, como forma organizativa del proceso docente, lleva el protagonismo para cumplir con esta misión, por lo que los escenarios de la Atención Primaria de Salud deben ganar cada vez mayor espacio en la formación de estos profesionales. Objetivo: Valorar la satisfacción de estudiantes y profesores de la carrera de Medicina con la educación en el trabajo desde los escenarios de la Atención Primaria de Salud. Métodos: Se realizó un estudio descriptivo de corte longitudinal durante el curso 2016-2017 en Santo Domingo, provincia Villa Clara. La muestra estuvo constituida por 26 estudiantes de Medicina de tercer año del Policlínico Universitario "Manuel Piti Fajardo", 24 alumnos de sexto año que hicieron su rotación de Medicina General Integral en este municipio, y 20 profesores que participaron activamente en la formación de estos educandos. La información se obtuvo mediante revisión documental y encuestas realizadas a estudiantes y profesores. Resultados: Predominó el buen desempeño de los estudiantes, al adquirir sus habilidades en los dos años de la carrera, así como la promoción en la convocatoria ordinaria. Los profesores, en su mayoría, eran asistentes y estaban preparados metodológicamente para desarrollar la educación el trabajo. Conclusiones: La mayoría de los educandos y profesores del estudio se consideraron satisfechos con desarrollar la educación en el trabajo desde estos escenarios(AU)

Introduction: Medical education is based on the principles of on-the-job training. As a form of organization of the teaching process, on-the-job training plays a leading role in fulfilling such a mission. Primary health care settings should therefore permanently expand their involvement in the training of these professionals. Objective: Determine medical student and teacher satisfaction with on-the-job training in primary health care settings. Methods: A longitudinal descriptive study was conducted in Santo Domingo, Villa Clara province, during the school year 2016-2017. The sample was 26 third-year medical students from Manuel Piti Fajardo University Polyclinic, 24 sixth-year students rotating in Comprehensive General Medicine in this municipality, and 20 teachers actively involved in the training of these students. Data were obtained from document review and surveys applied to students and teachers. Results: Good performance prevailed. Students acquired their skills in the two years assigned to them, and all passed their end-of-term exams in the ordinary call. Most teachers were Assistant Professors methodologically trained to lead on-the-job training tasks. Conclusions: Most of the students and teachers in the study reported being satisfied with participating in on-the-job training activities in these environments(AU)

7 años de DarocaFarmacias: programa de coordinación entre el Centro de Salud Daroca y los Farmacéuticos Comunitarios de su Zona Básica de Salud / 7 years of DarocaFarmacias: coordination program between Daroca Primary Health Center and Community Pharmaceuticals in a Basic Health Area

OBJETIVO: Evaluar el funcionamiento y el grado de satisfacción de los profesionales implicados en un programa de colaboración entre el Centro de Salud Daroca y las Farmacias Comunitarias de su zona de influencia (DarocaFarmacias) en Madrid, España. MÉTODOS: Participan 36 oficinas de farmacia y 81 profesionales sanitarios del centro de salud Daroca en un área urbana con 53.600 pacientes. Existe un correo electrónico y un teléfono directo en el centro de salud para facilitar la comunicación con las farmacias. Se realizan conjuntamente trabajos de investigación, sesiones de formación y actividades de educación para la salud. Se preguntó sobre los diferentes aspectos del proyecto (comunicación, relación interprofesional, sesiones de formación y satisfacción) mediante una encuesta anónima a los integrantes de DarocaFarmacias. RESULTADOS: Contestaron 67 profesionales (32 farmacéuticos, 21 médicos y 13 enfermeros). El 95,5% cree que ha mejorado la relación entre profesionales y el 82% que ha favorecido la comunicación. Para el 43,7% de los farmacéuticos la mejor vía de comunicación es el teléfono (92% de llamadas resolutivas), para el 31,2% el correo electrónico y el 53,1% ha acudido alguna vez al centro para resolver el problema. Acude a las sesiones de formación el 82% y resultan muy útiles para el 92,5%. El 91% de los profesionales está bastante o muy satisfecho con DarocaFarmacias. CONCLUSIÓN: DarocaFarmacias es un ejemplo de colaboración entre centros de salud y oficinas de farmacia en aras de una mejor atención a los pacientes

OBJECTIVE: To assess the performance and degree of satisfaction of the healthcare professionals involved in a cooperation programme between Daroca Health Centre and Community Pharmaceuticals in a Basic Health Area (DarocaFarmacias) in Madrid, Spain. METHODS: Thirty-six community pharmacies and 81 health care professionals of the Daroca Health Centre took part in this study, affecting an urban area of 53600 patients. Communications between Health Centre and Community Pharmacies were done by email and direct phone. Researching, clinical sessions and educational activities were collaboratively carried out. Different aspects of the project were analysed, such as communication, interprofessional relationship, training sessions and global satisfaction. With this aim, a blinded survey was submitted to the DarocaFarmacias members. RESULTS: Sixty-seven health professionals took part (32 community pharmacists, 21 physicians and 12 nurses) in the study. Among them, 95.5% are of the opinion that professional relationship improved and 82% agreed for a better-quality communication between health professionals. Most of the community pharmacists (43.7%) considered telephone as the preferred channel of communication (92% problem solving), followed by e-mail (31.2%), although half of them (53.1%) visited the Health Centre to solve a relevant question. Eighty-two out of 100 attended to the clinical sessions and educational activities, being considered as beneficial by 92.5% of them. Over nine out of ten (91%) of the health professionals were quite or very satisfied with DarocaFarmacias project. CONCLUSION: DarocaFarmacias is a positive experience of collaboration between Health Centre and community pharmacies in pursuit of a better attendance of the patients

Prevalence and risk factors of Occult Hepatitis C infections in blood donors from Mexico City.

BACKGROUND: The circulatory system is the main mechanism for transmission of the Hepatitis C Virus (HCV). A new class of HCV infections, Occult HCV infection (OCI), is defined as the presence of HCV-RNA in hepatocytes with the absence of HCV in the serum/plasma utilizing current laboratory assays. Different groups have reported the prevalence of OCI; however, its associated risk factors have not been established. In Mexico, there are no reports about OCI, so the objective of our study was to determine the prevalence of OCI in total blood donors in Mexico City, as well as its associated risk factors. METHODS: Blood donors that were considered eligible for donation, according to NOM 253-SSA1-2012, were randomly selected. Demographic data was collected from 1,037 donors. Plasma and peripheral blood mononuclear cells were assessed for HCV-RNA. The presence of HCV-RNA was determined by nested PCR for the 5'-UTR region. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (95%CI) to determine the level of association. RESULTS: The prevalence of OCI was 3.4% among blood donors. Homosexual relationships (OR = 5.52, 95%CI: 1.53-19.92, p<0.05) and acupuncture (OR = 3.56, 95%CI: 1.41-8.98, p<0.05) were significantly associated with OCI. CONCLUSION: There is a significant presence of OCI in the blood donor population in Mexico City. The main risk factors for OCI transmission are homosexual relationships and acupuncture. This study supports the increased use of sensitive and specific screening tests for blood bank testing.

Case report: Identification of recombinant HCV genotype 1b-2b by viral sequencing in two patients with treatment failure, who responded to re-treatment with sofosbuvir and daclatasvir.

Hepatitis C virus (HCV) infection is a global health problem. HCV has been classified into seven genotypes and >67 subtypes. Genotyping is necessary to enable selection of appropriate treatments. The commercial molecular techniques currently used do not identify some HCV subtypes, mixed infections and recombinant forms. In this study, the core-E1 and NS5B regions were sequenced and phylogenetically analysed to identify infections by HCV recombinant genotype 1b-2b in two patients who had initially been diagnosed with HCV genotype 2 infection by reverse hybridization with a Versant HCV Genotype 2.0 Assay. Response to treatment was monitored by viral kinetics. Therapeutic failure occurred with initial treatment with PEGylated interferon-α2b and ribavirin, but the use of sofosbuvir and daclatasvir on a re-treatment regimen after reclassification of the infecting virus resulted in a sustained virologic response. The use of a sequencing approach in treatment-naïve infected patients could enable physicians to select the optimal therapy and avoid possible relapses and adverse reactions associated with antiviral therapy.

Presence of rare hepatitis C virus subtypes, 2j, 2k, and 2r in Mexico City as identified by sequencing.

The HCV 5'UTR, Core/E1, and NS5B regions of samples from fifty patients infected with the hepatitis C virus (HCV) were analyzed. Seventeen patients were identified with genotype (GT) 1b, eleven with GT-1a, nine with GT-2b and four with GT-3a. Two rare subtypes were detected: GT-2j in two patients and GT-2r in one patient. Three patients had mixed infections: one with GT-2k + 2j and two with GT-1b + 2b. This work identifies HCV GTs, 2j, 2k, and 2r for the first time in Mexico.

Effect of branched-chain amino acid supplementation on insulin resistance and quality of life in chronic hepatitis C patients.

The incidence rate of insulin resistance (IR) in patients with chronic hepatitis C (CHC) is high. Recently, branched-chain amino acids (BCAA) have been shown to attenuate IR in CHC patients; however, their effect on patient quality of life remains unclear. Therefore, the aim of the current prospective study was to determine the effects of BCAA supplement on IR and health-related quality of life (HR-QoL) in patients with CHC. In the study, 20 non-diabetic patients with CHC, who were non-responders to peginterferon-α and ribavirin, were recruited. Patients took a BCAA supplement once a day (30 g, after a minimum 10-h overnight fast) for 3 months. Serum levels of glucose, insulin, albumin, triglycerides and cholesterol were measured at 0 and 3 months. Additionally, IR was measured using the Homeostasis Model Assessment-IR, HR-QoL was assessed using the 36-item Short Form Health Survey and viral load was measured by reverse transcription polymerase chain reaction using Taqman probes. The Wilcoxon signed-rank test was used to determine statistical significance. The results indicated that 70% of the subjects were positive for IR, which decreased to 50% by the end of the study; furthermore, 85% of the subjects demonstrated some level of improvement. Overall, the BCAA treatment significantly decreased IR (P=0.006) and augmented serum albumin concentration (P=0.008) compared with basal values. Additionally, by the end of the treatment, viral load and triglycerides levels had decreased, though these results were not significant (P=0.084 and P=0.080, respectively). BCAA treatment also improved HR-QoL regarding role limitations due to physical health problems (P=0.017), role limitations due to emotional problems (P=0.026) and social function (P=0.008). In conclusion, BCAA supplementation reduced IR and improved HR-QoL in patients with CHC. These findings support the application of IR therapy as a possible therapeutic strategy for hepatitis C infection.

Acciones metodológicas para implementar la estrategia curricular de Inglés con fines profesionales en Medicina / Methodological actions to implement the English language curricular strategy in English for specific purposes in medicine

Fundamento: la finalidad de la estrategia curricular Dominio del Idioma Inglés, propuesta por la subcomisión de estrategias curriculares de la Universidad de Ciencias Médicas de la Habana desde el 2009, es la competitividad idiomática de los profesionales de la salud. Objetivo: diseñar acciones metodológicas para la implementación de la estrategia curricular Dominio del Idioma Inglés en la carrera de Medicina de la Filial Universitaria Municipal de Santo Domingo. Métodos: se realizó una investigación de desarrollo con enfoque mixto entre enero de 2011 y diciembre de 2013; se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción y empíricos: análisis documental de la Resolución 210/2007, planes de trabajo metodológico y actas en los diferentes niveles organizativos, modelo del profesional y planes de clase; y la encuesta en forma de entrevista a directivos, y de cuestionario a docentes para identificar las principales insuficiencias en la preparación idiomática y metodológica. Resultados: se constató que las principales insuficiencias están relacionadas con la dirección y ejecución del trabajo metodológico interdisciplinar y con el pobre desarrollo de habilidades para la gestión de la información médica en idioma inglés, por lo que se diseñaron acciones metodológicas para lograr una mayor objetividad en la implementación interdisciplinar de esta estrategia que tribute al actual modelo del profesional de la salud. Conclusiones: las acciones fueron valoradas como pertinentes por criterios de especialistas, porque contribuyeron a transformar progresivamente la realización del trabajo metodológico para desarrollar una competencia idiomática interdisciplinar y profesional como garantía de un desempeño competente en contextos de habla inglesa.

Background: the purpose of the curricular strategy of the English Language command, proposed by the subcommittee of curricular strategies of Havana University of Medical Sciences since 2009 is the idiomatic competence of health professionals. Objective: to design methodological actions for the implementation of the curricular strategy of the English Language command in the Medicine career of Santo Domingo's Municipality Health University Site. Methods: it was carried out a development investigation with a combined approach from January 2011 to December 2013; theoretical methods were used: analysis-synthesis and induction-deduction and empiric ones: documental analysis of the 210/2007 Regulation from the Ministry of Higher Education , methodological plans and meeting records at different organizational levels, model of the professional and lesson plans; and the survey in interview form was applied to administrative leaders and a questionnaire was applied to the professors to identify the main inadequacies in the idiomatic and methodological preparation. Results: it was verified that the main inadequacies are related with the management and execution of the interdisciplinary methodological work and with the poor development of abilities for the medical information management in the English language, that's why methodological actions were designed to achieve a bigger objectivity in the interdisciplinary implementation of this strategy that contributes with the current model of health professionals. Conclusions: the actions were valued as pertinent by the specialists' criteria, because they contributed to transform the work with the methodological activity progressively to develop an interdisciplinary and professional idiomatic competence as guarantee of a competent performance in English-speaking contexts.

Acciones metodológicas para implementar la estrategia curricular de Inglés con fines profesionales en Medicina / Methodological actions to implement the English language curricular strategy in English for specific purposes in medicine

Fundamento: la finalidad de la estrategia curricular Dominio del Idioma Inglés, propuesta por la subcomisión de estrategias curriculares de la Universidad de Ciencias Médicas de la Habana desde el 2009, es la competitividad idiomática de los profesionales de la salud. Objetivo: diseñar acciones metodológicas para la implementación de la estrategia curricular Dominio del Idioma Inglés en la carrera de Medicina de la Filial Universitaria Municipal deSanto Domingo. Métodos: se realizó una investigación de desarrollo con enfoque mixto entre enero de 2011y diciembre de 2013; se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción y empíricos: análisis documental de la Resolución 210/2007, planes de trabajo metodológico y actas en los diferentes niveles organizativos, modelo del profesional y planes de clase; y laencuesta en forma de entrevista a directivos, y de cuestionario a docentes para identificar las principales insuficiencias en la preparación idiomática y metodológica. Resultados: se constató que las principales insuficiencias están relacionadas con ladirección y ejecución del trabajo metodológico interdisciplinar y con el pobre desarrollo de habilidades para la gestión de la información médica en idioma inglés, por lo que se diseñaron acciones metodológicas para lograr una mayor objetividad en la implementación interdisciplinar de esta estrategia que tribute al actual modelo del profesional de la salud. Conclusiones: las acciones fueron valoradas como pertinentes por criterios de especialistas, porque contribuyeron a transformar progresivamente la realización del trabajo metodológico para desarrollar una competencia idiomática interdisciplinar y profesional como garantía de un desempeño competente en contextos de habla inglesa(AU)

Patients with neck pain are less likely to improve if they experience poor sleep quality: a prospective study in routine practice.

OBJECTIVE: To assess whether sleep quality (SQ) at baseline is associated with improvement in pain and disability at 3 months. MATERIALS AND METHODS: Four hundred twenty-two subacute and chronic patients with neck pain (NP) were recruited in 32 physiotherapy, primary care, and specialized centers. NP, referred pain, disability, catastrophizing, depression, and SQ were assessed through validated questionnaires, upon recruitment and 3 months later. Correlations between baseline scores were calculated through the Spearman coefficient. Improvements in NP, disability, and SQ were defined as a reduction of ≥30% of baseline score. Six estimative logistic regression models were developed to assess the association between baseline SQ and improvement of NP, baseline SQ and improvement of disability, baseline NP and improvement of SQ, baseline disability and improvement of SQ, the evolutions of NP and SQ, and the evolutions of disability and SQ. RESULTS: Most patients were subacute and mildly impaired. Regression models showed that better SQ at baseline was associated with improvement of NP (odds ratio=0.91 [95% confidence interval, 0.83-0.99]), but not disability (1.04 [0.95-1.13]); the improvement of SQ was associated with more severe NP at baseline (1.26 [1.07-1.49)], but not with baseline disability (0.99 [0.97-1.02]); and that improvement in SQ was associated with improvements in NP (3.48 [1.68-7.20]), and disability (5.02 [2.39-10.11]). DISCUSSION: NP is less likely to improve in patients with poorer SQ, irrespective of age, sex, catastrophizing, depression, or treatments prescribed for NP. Future studies should confirm these results with more severely impaired patients.

Effectiveness of the Godelieve Denys-Struyf (GDS) method in people with low back pain: cluster randomized controlled trial.

BACKGROUND: The Godelieve Denys-Struyf method (GDS) is a motor learning intervention that may be applied in group or individualized sessions. OBJECTIVE: The study objective was to compare the effectiveness of routine physical therapy, group GDS (GDS-G) sessions, and group and individualized GDS (GDS-I) sessions. DESIGN: This was a cluster randomized controlled trial. SETTING: The study took place in 21 primary care physical therapy units ("clusters") of the Spanish National Health Service (SNHS). PARTICIPANTS: The participants were 461 people with subacute and chronic low back pain (LBP). INTERVENTION: Clusters were randomized into 3 groups. All participants received medical treatment and a 15-minute group education session on active management. Additional interventions were as follows: control (fifteen 40-minute sessions of transcutaneous electrical nerve stimulation, microwave treatment, and standardized exercises), GDS-G (eleven 50-minute group GDS sessions), and GDS-I (the same 11 sessions plus four 50-minute individualized GDS sessions). MEASUREMENTS: Primary outcomes at baseline and 2, 6, and 12 months later were LBP and pain referred down the leg (separate pain intensity numeric rating scales) and disability (Roland-Morris Questionnaire [RMQ]). Secondary outcomes were use of medication and self-reported health (mental and physical component summaries of the 12-Item Short-Form Health Survey [SF-12]). Separate linear mixed models for LBP, pain referred down the leg, and disability were developed to adjust for potential confounders. Randomization, outcome assessment, and data analyses were masked. RESULTS: At 12 months, disability improved 0.7 (95% confidence interval [CI]=-0.4, 1.8) RMQ point in the control group, 1.5 (95% CI=0.4, 2.7) RMQ points in the GDS-I group, and 2.2 (95% CI=1.2, 3.2) RMQ points in the GDS-G group. There were no differences in pain. LIMITATIONS: The amount of exercise was smaller in the control group, and GDS-I sessions were provided by junior physical therapists. CONCLUSIONS: The improvement in disability was slightly higher with group GDS sessions than with the program routinely used in clusters within the SNHS. Adding individualized GDS sessions eliminated this advantage. Further studies should compare the GDS with other types of exercise.